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Cochrane corner: is it better to access the coronary circulation via the radial or the femoral artery?
  1. Ahmed A Kolkailah1,
  2. Rabah S Alreshq2,
  3. Ahmed M Muhammed3,
  4. Mohamed E Zahran3,
  5. Marwah Anas El-Wegoud4,
  6. Ashraf F Nabhan5
  1. 1Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
  2. 2Department of Medicine, Albany Medical Center, Albany, New York, USA
  3. 3Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  4. 4Egyptian Center for Evidence Based Medicine, Cairo, Egypt
  5. 5Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  1. Correspondence to Dr Ahmed A Kolkailah, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, USA; a.kolkailah{at}gmail.com

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Background

Coronary heart disease is the most common cause of morbidity and mortality worldwide.1 Coronary artery disease (CAD) is a term referring to partial or complete blockage in blood supply to the heart. In a certain subset of patients with CAD, such as those with the acute coronary syndrome (ACS) and symptomatic patients despite optimal medical therapy, revascularisation of the blocked arteries is often indicated.2 Historically, coronary artery bypass grafting (CABG) has been the mainstay of revascularisation therapy. The advent of percutaneous coronary intervention (PCI) since the late 1990s, particularly with the development of drug-eluting stents, has increasingly challenged the role of CABG, with a growing momentum towards less invasive approaches.3 The gold standard for visualising coronary anatomy is diagnostic coronary angiography (CA) with an ultimate goal of intervention on the blocked or stenosed segment to restore blood flow to the ischaemic heart muscle. Access is achieved percutaneously via different approaches, most commonly the femoral artery and more recently, the radial artery. Each approach has its own inherent advantages and disadvantages, relating to the access site and technique as well as operator experience and learning curve.2 The objective of our Cochrane review was to compare the safety and effectiveness of both approaches in patients undergoing diagnostic CA and PCI across the whole spectrum of CAD.4

Methods

We searched for randomised controlled trials (RCTs) comparing the transradial and transfemoral approaches in adult patients (≥18 years old), of all genders, undergoing diagnostic CA and/or PCI for CAD in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and Web of Science Core Collection since their inception up to October 2017. We also searched WHO International Clinical Trials Registry Platform and ClinicalTrials.gov up to August 2017 for ongoing clinical trials.4 Cochrane standards were maintained and the Grading of Recommendations, Assessment, …

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